Today’s topic is about Stomatitis Nicotine. The name is a misnomer as it is not caused by nicotine.
In the early days I did not know much about this, but one day one of my neighbors came to me with a complaint of white patches on his hard palate.
The patient gave a history of tobacco smoking and most of the time he has a habit of reverse smoking.
In those days I was doing my first year undergraduate so I was not much exposed to patients/clinicals. The next day I shared my incident with one of my postgraduate residents and brought the patient into my college. She explained to me that it was a case of Stomatitis Nicotine.
I have seen many cases of Stomatitis Nicotina and ANUG.
Today I thought I would write an article about Stomatitis Nicotina.
Now let’s talk about nicotine Stomatitis
Table of Contents
WHAT IS STOMATITS NICOTINA?
Stomatitis Nicotina also known as Nicotine Stomatitis, Smokers palate. It is a white lesion seen on the hard and soft palate of people who are heavy cigarettes, pipe, and cigar smokers.
Some people used to smoke by keeping hand-rolled cigarettes and cigar is smoked with a burning end held within the mouth. This habit is called reverse smoking and the lesion associated is called reverse smoker palate.
The reason for this is that it creates more heat rather than an effect of tobacco.
WHAT ARE THE PALATAL CHANGES?
When you observe the hard palate you can see some whitish patches in the entire palatal mucosa and this condition is called keratosis.
When you touch with a probe you see an elevated nodule with a red dot in the middle which looks like an opening of the palatal mucosa.
Redding of the palate is present.
The white patches seen are well-defined and elevated.
Some areas are ulcerated which is crater-like and covered by fibrin.
WHAT ARE THE CLINICAL FEATURES?
They are commonly seen in the men who are pipe smokers.
As I discussed above it’s commonly seen in the palate. The palate looks like a white patch and is keratinized. They are seen in the area which is exposed to heavy smoking. In the initial stage, it looks red in color, and later on inflammation of the palate.
First, it becomes reddish in color and later on grayish white. It becomes thickened and fissured. These fissures and cracks make it wrinkled and irregular surface.
In severe cases, there will be multinodules.
The intraoral examination shows tonsilar pillars which become erythematous [redness seen in the mucous membrane].
One of the clinical features is the dried mud appearance.
That is, keratin present in the palate becomes so thickened that it imparts a fissured or dried mud appearance.
There are many salivary gland openings seen in the mouth. All these openings become discolourated.
WHAT IS THE DIAGNOSIS?
If a patient comes to you with a complaint of cigar or pipe smoking and reverse smoking then it gives a clue that it’s Nicotine Stomatitis.
The next step is to go for a biopsy. The biopsy report shows acanthosis [an increase in the number of squamous cells commonly seen in the mouth]. Also, hyperkeratosis means thickening of the outer layer of skin.
HOW WILL YOU MANAGE?
Next will discuss how you are going to manage this case.
The first step of management is the stoppage of habit. The smoking habit should be stopped compulsorily and this condition is reversible. After two weeks you can see changes in the palate.
If you see any kind of white lesion in your mouth that persists for one month biopsy has to be done.
As a part of the conclusion, I conclude that Stomatitis Nicotina is a condition seen in the hard palate. It’s mainly because of smoking. Stoppage of smoking is the main treatment as after two weeks you can the situation getting resolved.
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